Foley Catheter A Foley catheter is a thin, sterile tube inserted into your bladder to drain urine.

Because it can be left in place in the bladder for a period of time, it is also called an indwelling catheter. It is held in place with a balloon at the end, which is filled with sterile water to hold it in place. The urine drains into a bag and can then be taken from an outlet device to be drained. Laboratory tests can be conducted on your urine to look for infection, blood, muscle breakdown, crystals, electrolytes, and kidney function. The procedure to insert a catheter is called catheterization. A Foley catheter is used with many disorders, procedures, or problems such as these:

Retention of urine leading to urinary hesitancy, straining to urinate, decrease in size and force of the urinary stream, interruption of urinary stream, andsensation of incomplete emptying

Obstruction of

the urethra by

an

anatomical

condition

that

makes

it

difficult

for

you

to

urinate: prostate hypertrophy, prostate cancer, or narrowing of the urethra

Urine output monitoring in a critically ill or injured person Collection of a sterile urine specimen for diagnostic purposes Nerve-related bladder dysfunction, such as after spinal trauma (A catheter can be inserted regularly to assist with urination.)

Risks

Imaging study of the lower urinary tract After surgery

The balloon can break while the catheter is being inserted. In this case, the doctor will remove all the balloon fragments.

The balloon does not inflate after it is in place. Usually the doctor will check the balloon inflation before inserting the catheter into the urethra. If the balloon still does not inflate after its placement into the bladder, the doctor will then insert another Foley catheter.

Urine stops flowing into the bag. The doctor will check for correct positioning of the catheter and bag or for obstruction of urine flow within the catheter tube.

Urine flow is blocked. The doctor will have to change the bag or the Foley catheter or both. Your urethra begins to bleed. The doctor will have to monitor the bleeding. The Foley catheter may introduce an infection into the bladder. The risk of infection in the urine increases with the number of days the catheter is in place.

If the balloon is opened before the Foley catheter is completely inserted into the bladder, bleeding, damage and even rupture of the urethra can occur.In some individuals, long-term permanent scarring and strictures of the urethra could occur. Foley Catheter Preparation Equipments: Sterile gloves - consider Universal Precautions Sterile drapes Cleansing solution e.g. Savlon Cotton swabs Forceps Sterile water (usually 10 cc) Foley catheter (usually 16-18 French) Syringe (usually 10 cc) Lubricant (water based jelly or xylocaine jelly) Collection bag and tubing Keep the genital area clean. Switch to looser-fitting cotton clothing, and do not use chemical irritants in the genital area prior to having the catheter inserted. During the Procedure Urinary catheterization kits are sterile. They contain a Foley catheter, water-solublelubricant jelly, a 10cc syringe with sterile water for the Foley balloon, a sterile drainage bag with sample port and tubing, sterile drapes, sterile gloves, iodine, sterile gauze, sterile specimen cup, and forceps.

Female catheterization: The female urethra is short compared to the male urethra. It is located above the vagina in the pelvis.Insertion of the catheter is facilitated by having you lie down on your back with your buttocks at the edge of the examination table. Adequate exposure of the urethra is obtained by elevating and supporting your legs by stirrups or placing them in a frog-legged position. Finally, the labia are separated to expose the urethra. 1) Explain the procedure to the patient including the indication and the likelihood of some discomfort. Obtain verbal consent where possible. 2) 3) 4) 5) 6) 7) 8) Position the patient supine with her hips abducted and feet together (frog leg position). Place the catheter tray on a stand next to your dominant hand. Open the tray in an aseptic fashion and place any additional equipment such as the catheter on the sterile field. Put on sterile gloves. If using a Foley catheter, test the balloon by inflating and deflating it with the water-filled syringe. Open the Povidone - Iodine solution and pour it over the cotton swabs. Lubricate the tip of the catheter.

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Place the sterile drape around the genital area and then place the urine collection container between the patients legs.

10)

Gently separate the labia majora and minora with your non-dominant hand, exposing the urethra and vaginal orifice. This hand is no longer sterile and may not return to the sterile tray or equipment.

11)

Using your sterile hand, cleanse the genitalia three times with Povidone- Iodine. This is done with three separate swabs, each making a single pass from front to back. Discard the swabs away from your sterile field.

12) 13) 14) 15) 16)

Grasp the catheter in your sterile hand - hold it about two cm from the tip and coil the remainder in your hand. Insert the catheter gently into the urethra. If resistance or pain is felt, stop then gently try again. Continue to insert the catheter to its full length, collecting any urine in the sterile container. Inflate the balloon and withdraw the catheter until it firmly abuts the bladder neck. Connect the catheter to the drainage tubing and tape it to the patients inner thigh. Male catheterization: The male urethra is long compared to the female urethra. A catheter is placed while lying

down or in the frog-legged position. If there is a foreskin, it is retracted to its maximal limit. 1) Explain the procedure to the patient including the indication and the likelihood of some discomfort. Obtain verbal consent where possible. 2) 3) 4) Position the patient supine with legs slightly abducted at the hips Place the catheter tray on a stand next to your dominant hand. Open the tray in an aseptic fashion and place any additional equipment such as the catheter on the sterile field. The catheter is usually double wrapped with a sterile inner wrapper. 5) 6) Put on sterile gloves. If using a Foley catheter, test the balloon by inflating and deflating it with the water-filled syringe. The inflation valve will indicate the balloon capacity - usually 5 - 10 ml. 7) 8) 9) Open the Povidone - Iodine solution and pour it over the cotton swabs. Lubricate the tip of the catheter. Place the sterile drape around the genital area and then place the urine collection container between the patients legs. 10) Firmly (but politely) grasp the patients penis with your non-dominant hand. This hand is no longer sterile and cannot return to the sterile tray or equipment. 11) If the patient is uncircumcised, retract the foreskin using your unsterile hand. 12) Using your sterile hand, cleanse the glans penis, starting at the urethral meatus and circling outwards. Include the distal shaft of the penis. Repeat twice, discarding the swabs away from your sterile field. 13) If you plan to use Xylocaine viscous anaesthesia, place the injector tip inside the urethral meatus and inject slowly. 14) Using your unsterile hand, gently place traction on the penis upward to straighten the urethra.

15) Pick up the catheter with your sterile hand, holding it ~ 2 cm from the tip and coiling the rest into your hand. Insert the catheter into the urethra. Gently advance the catheter to the hilt, i.e. To the shoulder of the flared end. If you meet resistance, back up and gently try again. Never force. 16) Inflate the catheter balloon with saline and then gently pull the catheter back until the balloon comes up against the bladder neck. If there is resistance to balloon inflation or if the patient feels pain, re-advance the catheter to ensure it is in the bladder. Urine should now drain from the catheter into the sterile container. 17) Connect the catheter to the drainage tubing. Tape the catheter to the patients inner thigh. 18) Retract the foreskin in uncircumcised patients.

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Drainage bag While at the hospital, the urinary drainage bag will be hung to the bedside rail by a hook on the bag. If you need to be discharged from the hospital and sent home wearing the Foley catheter, the drainage bag will be replaced with a portable drainage bag (leg bag). Adhesive tape will be used to hold the bag to the calf area.

Removal of the catheter and bag The catheter balloon is deflated by inserting a syringe into the catheter valve and pulling back on the syringe. The pressure in the balloon will cause the water to flow into the syringe. Once the balloon is empty, the Foley catheter can be pulled out.

After the Procedure

A slight irritation in the urethral area may be felt. Switch to looser fitting cotton clothing. Do not use chemical irritants in the genital area and keep the area clean. Complications

The main complications are tissue trauma and infection. After 48 hours of catheterization, most catheters are colonized with bacteria, thus leading to possible bacteruria and its complications. Catheters can also cause renal inflammation, nephro-cysto-lithiasis, and pyelonephritis if left in for prolonged periods.

The most common short term complications are inability to insert catheter, and causation of tissue trauma during the insertion. The alternatives to urethral catheterization include suprapubic catheterization and external condom catheters for longer durations.

Report 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) Gather equipment. Explain procedure to the patient Assist patient into supine position with legs spread and feet together Open catheterization kit and catheter Prepare sterile field, apply sterile gloves Check balloon for patency. Generously coat the distal portion (2-5 cm) of the catheter with lubricant Apply sterile drape If female, separate labia using non-dominant hand. If male, hold the penis with the non-dominant hand. Maintain hand position until preparing to inflate balloon. Using dominant hand to handle forceps, cleanse peri-urethral mucosa with cleansing solution. Cleanse anterior to posterior, inner to outer, one swipe per swab, discard swab away from sterile field. Pick up catheter with gloved (and still sterile) dominant hand. Hold end of catheter loosely coiled in palm of dominant hand. In the male, lift the penis to a position perpendicular to patient's body and apply light upward traction (with nondominant hand) Identify the urinary meatus and gently insert until 1 to 2 inches beyond where urine is noted Inflate balloon, using correct amount of sterile liquid (usually 10 cc but check actual balloon size) Gently pull catheter until inflation balloon is snug against bladder neck Connect catheter to drainage system Secure catheter to abdomen or thigh, without tension on tubing Place drainage bag below level of bladder Evaluate catheter function and amount, color, odor, and quality of urine Remove gloves, dispose of equipment appropriately, wash hands Document size of catheter inserted, amount of water in balloon, patient's response to procedure, and assessment of urine